Thank you for your question.
You’re 54 years old and it's two months since you've undergone what you describe as
a mid-facelift.
You've described your history where you've done Botox, IPL, and you've dealt with some
of the lines and issues you had in the past.
You're currently disappointed in the appearance of the outer corners of your mouth and what
you described as Smoker’s Lines.
In reviewing the two photos that you submitted, it's clear that essentially there is a change.
Just to give you a little bit about my background, I am a Board-certified cosmetic surgeon, and
I'm also a Fellowship-trained oculofacial plastic and reconstructive surgeon.
I specialize in facial aging, I’ve written books about facial aging, and I've been in
practice in Manhattan and Long Island for over 20 years.
I do a lot of cosmetic eyelid surgery and all types of face lifting surgeries, as well
as facial implants.
I also do a lot of non-surgical treatments of facial aging.
So, with that out of the way, looking at your photos and just the lower part of your face,
it's clear that your neck appears to be improved from your pre-treatment photo, as well as
the jaw line and the area around your mouth.
What I think you're probably understanding is the revealing of the volume loss that is
associated with facial aging.
In consultation with my patients about cosmetic surgery, particularly face lifting surgery,
I always explain that when we do a facelift, we are restoring one significant element of
facial aging and that element is descent.
Descent of the soft tissue of the face, the fat the skin, and the underlying structure
called the SMAS, also known as the superficial muscular aponeurotic system.
This is the layer often referred to as the muscle that is lifted in whatever way is appropriate
for the patient, in order to provide a foundation or a support.
In addition we do things, as it appears in your situation, like a platysmaplasty, which
is to address the neck bands and to improve the angle of the neck and to, overall, put
everything back to where it should be.
The other side of this is that facial aging is also volume loss.
Volume loss means that there is loss of bone, muscle, fat, soft tissue.
There are times when I see a patient where I will recommend the placement of facial implants
as part of that.
For example, along the jawline, there is a little depression on the sides which is referred
to as the mandibular notch.
Even when you lift the face aggressively, the skin will go in in that area, so it's
not unusual to put a chin implant or a pre-jowl implant in order to fill that area.
Now there are also other options that we do later.
The same does apply for the mid-face, such as the placement of cheek implants.
Now that being said, what has also been a trend for us in our practice is during consultation
the patients can sometimes be overwhelmed by thinking of not only getting the lift but
also about the different facial implant options.
So it is very important when we do our discussions that we describe where there will still be
a need for volume enhancement, and I think there may have been some miscommunication
between you and your doctor about that issue after the procedure.
I always explain that the face lifting procedure restores structure, and then fillers will
restore volume, and that includes Botox and injectables such as Restylane and Juvederm.
In fact, a good number of my past facelift patients who’ve come in, we've been doing
variations of what is called the Y Lift, and essentially this is a method of placing hyaluronic
acid filler such as Juvederm and Voluma in the deeper levels of the facial structure,
adjacent to the bone structure and below the muscle.
What we found is that after the lift is done, if someone has volume loss in the cheek area
or volume loss in the chin or jowl area, doing the Y Lift method to fill those areas has
really been extremely effective.
In addition, around the mouth there is always a need for a combination of filler such as
Restylane, Juvederm and hyaluronic acid to outline the lips, to maybe add some lip volume,
as well as the use of laser to help improve vertical lines around the mouth.
We also commonly use platelet-rich plasma to help these areas as well.
Because you're talking about building collagen and again, we're talking about restoring volume.
So I think that this is a discussion that you should have with your surgeon about addressing
these issues.
It's understandable that you're concerned about the cost but when it comes to maximally
improving your face, so that you address both the sagging and the volume loss, there is
invariably some degree of maintenance needed.
Now this is all in the eye of the patient.
A lot of times, a patient who wants volume improvement can be satisfied with a very limited
placement—they don't need to have a lot of injectables.
A lot of times a combination of outlining the lips and improving the cheeks and improving
the chin can make a world of difference.
So this is about communication with your doctor and seeing what kind of strategy is ideal
after you've completed the healing period.
Something to be aware of is that two months after surgery, there is still going to be
some degree of swelling from the facelift, which means you may even notice more volume
loss as the swelling comes down.
A lot of times people look extremely good within the first couple of weeks after a facelift
because there's some swelling and swelling smooths out the wrinkles and compensates for
some of the volume loss.
I know that's not the best news to hear but it's important that you really understand
what you're going through at this point in time.
So I hope that was helpful and I wish you the best of luck.
Thank you for your question.